Inflammatory mediators, such as oxidants, TNF-alpha, and IL-6, play a major role in the systemic response to bum injury It has been known that a continuing inflammatory response cause a sepsis and subsequent multiple organ failure. Recent studies have shown that burn patients receiving recombinant human growth hormone(rhGH) therapy have an improvement of the general condition, but the mechanism by which rhGH exerts its effects has not been clearly understood. The aim of this study was to evaluate the effect of rhGH on the early bum injury. Female Sprague-Dawley rats were divided into four groups : control group, bum group, burn plus rhGH treated group, and rhGH only treated group. Animals were killed at 30min., 3, 6, 24, and 48 hours after treatment. Histology and biochemical changes including malondialdehyde(MDA) content, tissue reduced glutathione(GSH) and catalase activity in the lung and liver, and plasma TNF-alpha and IL-6 levels were examined. Lung histology in the bum plus rhGH treated group showed decreased inflammtory response such as neutrophil and lymphocyte infiltrations, interstitial thickening, and edema compared with the bum group. Liver histology in the bum group revealed mild neutrophil and lymphocyte infiltrations, vacuolization .of hepatocytes, disrupted lobular structures, and dilated sinusoids. But liver histology of the bum plus rhGH was similar to control group. Lung and liver MDA in the burn plus rhGH and rhGH only treated groups were decreased with time compared with the burn group. Lung and liver GSH and catalase activities in the bum plus rhGH and GH only treated groups remained significantly increased compared with the bum group for the 48-hours period. Plasma TNF-alpha levels in the bum group remained elevated for the 48-hours period compared with the bum plus rhGH and rhGH only treated groups. Plasma IL-6 levels in the burn group were significantly increased only at first compared with the bum plus rhGH and rhGH only treated groups. These results suggested that rhGH showed inhibitory effects on the inflammatory cell infiltration and lipid peroxidation in the lung and liver after bum injury. Increased GSH levels and catalase activities seemed to be associated with the antioxidant effect of rhGH. But the inhibitory effect of rhGH on plasma TNF- and R-6 levels was not clearly demonstrated.
Animals ; Antioxidants ; Burns ; Catalase ; Edema ; Female ; Hepatocytes ; Human Growth Hormone* ; Humans* ; Interleukin-6* ; Lipid Peroxidation* ; Liver ; Lung ; Lymphocytes ; Multiple Organ Failure ; Neutrophils ; Oxidants ; Plasma* ; Rats* ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha*

Impact injuries to the surgically exposed dura overlying the lumbar cord at L2 were produced in cats. Cytochrome oxidase activities in frozen-dried sample of spinal cord gray matter were measured and analyzed as a step in the investingation of the possible effects of spinal cord trauma on mitochondria. As conservative index of mitochondria damage in gray matter resulting from inactivation on cytochrome oxidase activity, electron microscopic studies of mitochondrial ultrastructural changes in traumatized gray matter were performed. The effects of Naloxone on the alteration of the cytochrome oxidase activities and ultrastructures of the mitochondria in the gray matter were studied. A drop in cytochrome oxidase activities to approximately 50% of normal value was found as early as 15 minutes post-trauma, which greatest decrease at 1/2 hour and 1 hour post-trauma. Ultrastructural changes of the mitochondria continued to proceed with the lapse of time after the injury. Mitochondriae were slightly enlarged with decreased number of cristae at 15 minutes post-trauma. Enlargement of the mitochondria with disintegration of cristae and electron-lucent area in the matrices were observed at 1 hour and 4 hour post-trauma. As relatively less change to the mitochondrial ultrastructures was observed in the Naloxone-treated group than in the non-treated group, the results of this study suggest that Naloxone confers beneficial effects in enhancing the cytochrome-oxidase activity and preserving the mitochondrial ultrastructures from injury.
Animals ; Cats ; Cytochromes* ; Electron Transport Complex IV* ; Mitochondria ; Naloxone* ; Reference Values ; Spinal Cord Injuries* ; Spinal Cord*

A normal-weight full-term newborn infant with a posterior fossa subdural hematoma is described. This potentially trea table condition has been previously diagnosed in only 13 reported cases. The clinical characteristics in this case were the lack of specific symptoms and signs indicating the nature and location of the lesion and the presence of signs of intracranial hypertension. Computed tomography allowed for earlier confirmation of the diagnosis and early surgical treatment resulted in excellent recovery.
Diagnosis ; Hematoma, Subdural* ; Humans ; Infant, Newborn* ; Intracranial Hypertension

PURPOSE: The instruction of cardiopulmonary resuscitation (CPR) to students has been advocated in many countries. To formulate an effective policy for high school students in Korea, data on attitudes toward CPR and the levels of knowledge in this technique for this population are needed. METHODS: A thirty-question questionnaire was given to Korean high school juniors to assess their attitudes toward and knowledge level of CPR. Two hundred seventy one of 341 students (79.5%) responded to the questionnaire and their male to female ratio was 1:2.2. RESULTS: Most students (n=262, 96.7%) had heard of CPR, mainly through television (n=193, 71.2%) or a school activity (160, 59.0%). Only 50(18.5%) and 15(5.5%) students responded that they would be willing to provide CPR to a "family or friend" and "stranger", respectively. One hundred twunty four students (45.8%) had received some form of education on CPR, but only 10(3.7%) had received an advanced education (although most were willing to be educated further on CPR). The most common reason for not receiving CPR training was a lack of knowledge for training resources (n=79, 53.7%). Only 88(32.4%) students understood the purpose of an automated external defibrillator. Although half of the students (147, 54.2%) correctly chose the location for CPR chest compression, only 19.2% and 16.6% correctly responded to questions on the appropriate compression speed and depth, respectively. CONCLUSION: Although students receive some exposure on the importance of CPR, their willingness to perform CPR and their knowledge level of AEDs and CPR is not adequate. A systemic approach for educating and training students in CPR is needed.
Cardiopulmonary Resuscitation ; Defibrillators ; Female ; Humans ; Korea ; Male ; Surveys and Questionnaires ; Television ; Thorax

A case of the tuberous sclerosis, 14-years old boy, was observed. In his father and sister, the cerebral tubers were noted by brain computerized tomography. This disease has been reported occasionally in dermatologic and psychiatric department because of adenoma sebaceum, mental retardation and epilepsy respectively, but it has not been reported at neurosurgical department in Korea. The histopathology of the brain lesion showed atypical cell(tuberous sclerosis cell), gliosis and nonspecific calcification which confirmed the diagnosis of tuberous sclerosis.
Adolescent ; Brain ; Diagnosis ; Epilepsy ; Fathers ; Gliosis ; Humans ; Intellectual Disability ; Korea ; Male ; Sclerosis ; Siblings ; Tuberous Sclerosis*

Chronic subdural hematoma is a relatively common disease which is practically always secondary to severe or minor injury to the head but may occur in connection with blood dyscrasias or cachexia in the absence of trauma. Early diagnosis and proper operative treatment result in complete recovery in most cases, but the outcome without operative treatment is almost invariably fatal. During 1972 to 1975, 28 patients with chronic subdural hematoma were examined and operated in the Department of Neurosurgery, Korea University, and clinical observation and analysis were made particularly of the relationship of age to clinical and pathological findings. Incidence of hematoma was predominated by men and estimated as 71.4% of total cases over the age group of 31 to 40 years and In the group of under 10 years were found in 3 cases A history of craniocerebral trauma in varying degrees was obtained in 23 cases(82%), and remainings had no history of it or any other illness. The average time interval from trauma to operation was 31.7 days and it was shorter in the young patients who had more evidence of increased intracranial pressure. The prevalence of the most commonly encountered symptoms and signs, especially in different age groups were analyzed. Headache was by far the commonest symptom in this series, being present in 20(71.4%) vomiting in 15(53,6%), hemiparesis in 13(16.43%) speech disturbance in 5(18%), papilledema in 16(57.2%), and convulsion in 2(7.14%). There was a tendency that young patients had headache more frequent and severe than the older patients, while mental symptoms, such as somnolence, confusion, and memory less were significantly more frequent in the older age group. Hemiparesis and other pyramidal tract signs were more frequent in the older age group. Leukocytosis in peripheral blood was investigated in 75% of cases and roentgenograms of the skull showed evidence of a linear fracture in 10 of the total cases. Carotid angiograms were of diagnostic value in that they demonstrated a lentiform shaped avascular zone by in 28% and a crescent shaped-one in the remainders by an inward displacement of the terminal branches of the middle cerebral artery. The hematomas were most frequently found in the parietotemporal region. The thickness of the hematomas as measured from angiograms increased with the age of the patient. Only 1 of 28 cases died of reaccumulation of blood in the subdural space and bleeding in the gastrointestinal tract following the operation. Excellent recovery following operation is obtained in 82% of the cases at the time of discharge from hospital.
Cachexia ; Craniocerebral Trauma ; Early Diagnosis ; Gastrointestinal Tract ; Head ; Headache ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Incidence ; Intracranial Pressure ; Korea ; Leukocytosis ; Male ; Memory ; Middle Cerebral Artery ; Neurosurgery ; Papilledema ; Paresis ; Prevalence ; Pyramidal Tracts ; Seizures ; Skull ; Subdural Space ; Vomiting

PURPOSE: Tethered cord syndrome(TCS) is defined as low position of the conus medullaris by the abnormally fixed spinal cord with progressive neurologic deficit MATERIALS AND METHODS: To evaluate the findings of TCS at MRI and its diagnostic value, we performed a retrospective analysis of MRI of 30 patients with emphasis on clinical manifestation, level of conus medullaris, cause of tethering, and associated findings. RESULTS: Clinical presentation included back mass(26 cases), neurogenic bladder(5 cases), urinary incontinence(5 cases), progressive constipation(2 cases), skin dimpling(1 case), gait disturbance(1 case) and club foot (1 case). Neurologic deficit was developed in 11 cases(40% and mean age of these patients at the time of diagnosis was 8.6 years. The most common cause of tethering was lipoma(63%). The tips of conus medullaris were below the level of the second lumbar spine in all patients. The causes of tethering were lipomatous component(spinal lipoma and lipomyelomenigocele) in 67% myelomeningocele in 20%, presacral mass in 7%, thickened filum terminale in 3% and postoperative change in 3%. Associated anomalies included syringomyelia(20%) and hydrocephalus was associated in 3 out of 5 patients who underwent brain MRI. CONCLUSION: MRI clearly delineated the location of conus, tethering of the filum terminale with their causes and associated abnormalities. MRI examination is a very useful diagnostic tool for the early evaluation of TCS and the postoperative follow up.
Brain ; Cauda Equina ; Conus Snail ; Diagnosis ; Follow-Up Studies ; Foot ; Gait ; Humans ; Hydrocephalus ; Lipoma ; Magnetic Resonance Imaging ; Meningomyelocele ; Neural Tube Defects* ; Neurologic Manifestations ; Retrospective Studies ; Skin ; Spinal Cord ; Spine

Tuberculous meningitis, which commonly causes thick granulations over the base of the brain, is a frequent cause of post-meningitic hydrocephalus. Raised intracranial tension affects the cause of tuberculous meningitis adversely. The development of hydrocephalus may account for the raised intracranial pressure. Insertion of a V-A(V-P) shunt significally alters the course of the disease. The results in 5 cases have been detailed and discussed. Operation could be performed even in an active stage of the disease without much fear of milliary dissemination.
Brain ; Hydrocephalus* ; Intracranial Pressure ; Tuberculosis, Meningeal*

Nimodipine the potent, centrally active, clacium channel blocker, is known to increase cerebral and spinal blood flow. In the present study, the authors investigated the effect on Nimodipine on injured spinal cord. The experiment was a randomized blind study in which four groups of five cats received Nimodipine(0.05mg/kg) intravenously, and control groups of five cats received only Diluent. As a step in the investigation of the possible effect of spinal cord trauma on biochemical and ultrastructural changes in the injured cord, activities of lipid peroxidation were measured in the frozened-dried sample of the spinal cord and fine structure of the mylinated nerve fiber in the white matter were observed. An increase of lipid peroxidation level was found as early as 1 hour after the injury and the highest concentration was reached at 5 hours after the injury(P<0.01). Fine structures of the myelinated nerve fibers were changed progressively with the lapse of time after the injury. The effect of Nimodipine on lipid peroxidation and fine ultrastructural changes of myelinated nerve fibers were studied, and the result of this study revealed that Nimodipine groups showed a lower level of lipid peroxidation with statistical significance(P<0.05) and preservation of ultrastructural myelinated nerve fiber was prominent.
Animals ; Cats ; Lipid Peroxidation ; Nerve Fibers ; Nerve Fibers, Myelinated ; Nimodipine* ; Spinal Cord Injuries* ; Spinal Cord*

This study reports the protective of systemic nicardipine and intracisternal nicardipine administration in the three-hemorrhage canine model of chronic cerebral vasospasm. Twenty-one dogs were assigned to one of three groups : control, intravenous nicardipine, and intracisternal nicardipine. All animals received a total of 12ml of fresh unheparinized autologous blood via three cisternal injection. Selective vertebral angiograms were obtained before intravenous nicardipine for 7 days continuously, the other seven were treated by intracisternal nicardipine for 7 days, and the remaining were not treated. Animals were sacrificed at day 9. Comparisons were based on the percentage of reduction in basilar artery diameter(% RBAD). The ultrastructural changes were studied by transmission electron microscopy(TEM). There was a mean reduction(+/- standard deviation) of 54+/-6% in control dogs, 35+/-4% in dogs with intravenous nicardipine, 32+/-6% in dogs with intracisternal dicardipine(difference significant, t-test, P<0.05). The preventive effects of intracisternal nicardipine was superior to those of intravenous nicardipine. There was a strong trend toward reduction of medial necrosis in the basilar artery in dogs with intravenous and intracisternal group compared to control dogs. All basilar arteries showed structural changes with celectron microscopic examination ; these included medial necrosis, lysosome, initial changes, endothelial cell vacuoles, and adventitial erythrocytes, leukocytes. Intimal proliferation was unusual in all three groups, but reduction of intimal proliferation was found in dogs with treatment, and it was believed that vasospasm in this stage is due to long-standing smooth muscle contraction and not to arterial wall thickening. There was significant reduction of blood clot in intracisternal nicardipine group, which may be due to inhibitory action on platelet aggregation of nicardipine. These investigations support the hypothesis that the presence of clotted blood around the intracranial arteries is the cause of vasospasm.
Animals ; Arteries ; Basilar Artery ; Dogs ; Endothelial Cells ; Erythrocytes ; Leukocytes ; Lysosomes ; Muscle, Smooth ; Necrosis ; Nicardipine* ; Platelet Aggregation ; Vacuoles ; Vasospasm, Intracranial*